Ileoanal Pouches - Is Mucosectomy Essential?

Abstract

(IPAA) with mucosectomy after pmctocolectomy eradicates ulcerative proctocolitis, restores anorcctal function, and avoids a permanent denstomy. Its disadvantages include increased stooling frequency, imperfect continence especially at night, and rouchitis. Heal pouch-disral rectal anastomosis (IP()RA) without mucosectomy promises to 1mprnve nighrtime continence by preserving the mucosa of the anal tramitional zone. Thus far, in controlled trials stool frequency anJ contmcnce after ll'DRA do not differ from that reported after IPAA with mucosect()lny. It is unlikely that the risk of pt)uchitis will be diminished. However, the drawbacks of IPDRA relate to the residual diseased muco~a which may predispose patients to recurrent procticis anJ associated symptoms, mcluding persistent extracolonic manifestations, leading ultimately to poor functional results and mcrcascJ risk of cancer. Therefore, !PAA with complete mucosectomy is preferable tu IPDRA and continues to he the procedure of choice; it cures patients of the colitis, has broader indications, and appears to provide postoperative neorectal function comparnhle to that offered by ll'DRA.